The conclusion of "alteration of effort preference" driving PEM from an underpowered study that blatantly misuses CPET in the face of all relevant research and clinical guidance for ME/CFS is what we get after years of developing the protocol and waiting for these results?
The sample size makes this study a glorified case series. In a heterogeneous condition like ME/CFS, there is no way 17 participants out of 217 screened is representative. But get this: not all the participants got all the endpoint measures. How can the authors infer causation?
For sure the CPET results are underpowered but there are some clear differences between groups. The authors interpret these differences as deconditioning, which is easy to do on the basis of a single CPET. That's why you need the second one completed in the post-exertional state.
One revealing thing from CPET was the fact the authors included obviously trained individuals in their analysis. Half of them performed at or above their age-predicted maximum heart rate. If you want to conclude PEM is deconditioning and altered effort preference, at least...
...make this comparison with sedentary people who are likely to be deconditioned instead of relatively fit individuals.
PEM is tricky because simply trying to measure it can induce it. The authors didn't grasp this important concept. The effort preference task is a lengthy complex choice reaction time task. This just sounds like the perfect way to induce cognitive PEM during a measurement.
So, there will be a lot more said about this study in the weeks and months to come, and most of it will be about how this study wasn't worth the resources, time, and waiting. For now I'll just contribute that Nature editorial staff were asleep at the wheel, ...
... there were plenty of people who had to do with this work who had reason to know better than what they put out both from basic scientific and content area perspectives, and this work is so poorly interpreted and so poorly reported that it should be retracted immediately.
This article reinforces every negative stereotype about PEM simply being a choice. It's so inconsistent with the findings of their own -omics analysis, to let alone the extant literature. And in light of that inconsistency, it's inhumane. People with ME deserve better than this.
There may be some useful details of this work stuck between the couch cushions, but they won't make the global headlines. What will make those headlines are people with ME are either lazy or crazy. Again.
What an utter and total waste of resources and good faith. I just can't.
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